Meaningful Relationships vs Meaningful Use: Concierge Care

By Dr. Raymond Zakhari, NP

Concierge medicine is rapidly gaining traction among people who are looking to establish a meaningful relationship with their primary care provider. Patients are yearning to experience a different kind of medical care – one where their doctor spends quality time with them instead of rushing off to complete paperwork, or see the next person in a crowded waiting room of patients. A few years ago, doctors were always ready and able to drop everything and tend to the needs of their patients. “Family doctors” had a relationship-based model of care, and made house calls.

Unfortunately, insurance companies and mounting government mandates have reduced health care to a list of codes, and endless forms. Patients are known by a string of numbers. Both doctors and patients are made to conform to the new regulations of the day. The traditionally practicing health care provider has a second full time job as a data entry clerk. Patient-focused services have eroded over time. Suddenly, the doctor-patient relationship is a business arrangement consisting of fast in, fast out, drive by physical exams, impersonal and fragmented care, and increased ER and Urgent care visits.

Do you find that your current annual physical leaves something to be desired? Are you sure that you know as much as you can about your health? If you are like most busy people here in New York, your annual physical does not provide you with full information about your health. Have you ever felt that your doctor could not provide you with the care you needed and have been rushed along? Are you tired of competing for your doctor’s attention? Are you fed up with calling to book an appointment and waiting on hold for hours, only to learn that the next available date isn’t for six months, and speaking to impersonal curt front of the house staff? If you’re one of the thousands of patients who has felt this way, it is likely because your doctor is one of the many overbooked Primary Care Providers/ Data Entry Clerks.

A Concierge Nurse Practitioner eliminates the need to chase your doctor and to try and fit yourself into his or her already overbooked slot. A concierge Nurse Practitioner deliberately plans enough time to talk to you as the most important member of your health care team. A Concierge Nurse Practitioner is willing to spend as much time as needed to uncover any potential issues with your health.

If you are ready to take control of your health care with a board certified primary care provider that has the time to focus on you, then you would greatly benefit from the expert care of a nurse practitioner. Concierge care allows you to experience relationship-based primary care, and return to the good old days, of house calls, compassionate care, talk therapy, and a complete understanding of your diagnosis and treatment options. Join this movement to revitalize medical care, with a nurse practitioner that values your business and respects your time.

You have a wealth manager, but not a health manager?

A health manger more commonly known as a concierge physician can be one of your most valuable consultants.  If your personal physician is not providing you with the time and attention to detail you need and deserve perhaps it is time to switch or get a second opinion. 

Making time for individualized preventative care can be difficult. Perhaps an executive health physical may be the perfect solution to your time constrained life in New York City and abroad.

What is an executive health physical and do you have to be an executive to get one?

First, you do not have to be an executive to have an executive health physical exam.  It helps if you have the salary of an executive as these comprehensive exams are usually not covered by insurance.  An executive health physical is simply a comprehensive physical exam and health assessment that helps you and your primary care provider stratify risk for disease over time. 

An executive health physical begins with a one-on-one meeting with your primary care provider in which a detailed comprehensive health history is reviewed.  Special attention will be given to your family history and lifestyle to uncover modifiable risk factors.  As part of your comprehensive health history your primary care provider will review your current diet, exercise, sleep, and sexual practices. After your comprehensive health history is revealed a hands on head-to-toe examination will be done. For men this will include a urogenital prostate exam and for women you will be referred for a gynecologic exam.   

Following your comprehensive history and physical exam your primary care provider may consider ordering various blood tests for screening and diagnosis.  Additionally, non-radiation imaging studies, and sensory tests (Vision, and Hearing) may be prescribed to provide a more detailed look at your physiology.  The tests ordered should be judiciously considered so as to not increase the likelihood of false positive findings.  False positive test results compound stress and increase the risk of harm. For this reason total body scanning is generally not a prudent idea for screening purposes. There is a very high risk of incidental findings without clinical significance in general body scanning. 

In addition to the comprehensive history and physical exam you should also receive a comprehensive psychiatric evaluation (not for the purpose of necessarily identifying a mental illness), but for identifying coping mechanisms and risk factors for maladaptive coping in the future.  A comprehensive psychiatric evaluation can provide you the anticipatory guidance necessary to relieve your stress at the different ages and stages throughout your lifespan.  Mental illnesses such as depression and anxiety schizophrenia and bipolar would have likely been discovered prior to your executive health physical. Less known but more common conditions such as dysthymia, adjustment disorders, dysfunctional grief, addiction, PTSD, insecurities and phobias will also be screened.  The comprehensive medical history, complete physical exam and the psychiatric evaluation are the three components that comprise an executive health exam. 

After this comprehensive evaluation is completed you will now have established a foundation for a participatory care relationship with someone that knows you very well. Now you have a relationship with a medical trained consiglieri whom you can call on in your times of need.  A modifiable personal wellness plan can be implemented with your coach at your side.

What happens if you need a specialist?

Should you need consultation from a sub-specialist a facilitated referral will be arranged.  Specialists are selected from renowned institutions in the New York City area.              

How great would it be if you had guy that could conveniently and confidentially take care of you and your family?